Sonomorphologische Charakterisierung peripherer pulmonaler Konsolidierungen- Evaluierung mit B-Mode-Thoraxsonograhie und farbkodierter Dopplersonographie

Pulmonary consolidations can be evaluated by sonography if there is contact to the Pleura parietalis. Pleural effusions and atelectasis function as "acustic windows" to depict intrapulmonary consolidations. The aim of this prospectiv study was to characterize the B-Mode and Color Doppler sonomorphologic features of peripheral pulmonary leasons and to determine sensitivity, specificity and diagnostic validity. The patients were included in this study according to there chest x-ray results. The following terms of admission were used: in chest x-ray visible pulmonary consolidation of at least 1,5cm; contact to Pleura parietalis; patient`s informed consent; confined diagnosis. We examined 102 patients, 98 were included. The age ranged from 17 to 88 years. We designed an evaluation paper to report all sonographic results. The sonomorphology of each lung leason was recorded as color prints. We found three major diagnoses: pneumonia, tumor and atelectasis. For statistic evaluation we used the Chi-Quadrat-Test (form, margin, echotexture, vascularisation) and Kruskal-Wallis and T-Test (resistive index, pulsatility index). To assess the diagnostic value of thoraxsonography sensitivity, specificity and validity were calculated. The diagnosis at discharge from hospital or post mortem examination was set as gold?s standard. According to our datas the sonomorphology of peripheral pulmonary consolidations appears as follows: pneumonias are wedge-shaped in 53%, irregular in 35% and have a blurred margin in 66%. The echotexture appears hypoechoic and inhomogenous in 94%. In 60% an airbronchogramm, in 48% a pleural effusion can be found. The Color Doppler Sonography shows a hypervascularisation in 91% with pulsatil flow patterns and an average resistivity index of 0,8 and pulsatility index of 2,57. Tumors are polycyclic in 49%, circular in 27%, have a sharp margin in 79% and a hypoechoic homogenous texture in 79%. In 25% the Pleura parietalis is thickened. An airbronchogramm never appears in tumors, in 12% scattered air inlets are visible. Bone destruction and invasion of the thoracic wall are firm signs of malignity. The Color Doppler Ultrasound of tumors shows a hypovascularisation in 85%, arterial flow patterns with little systolic-diastolic variation and an average Ri of 0,66 and Pi of 1,72. Atelectasis are wedge-shaped in 62%, irregular in 24% and have a sharp margin in 67%. The echotexture is hypoechoic and inhomogenous in 62%. Pleural effusions compress lung tissue depending on the amount of fluid and so cause an atelectasis. In this type of atelectasis airbronchogramm can be seen. Obstructive atelectasis present a fluidbronchogramm. In Color Doppler examination atelectasis show a hypervascularisation in 81% and a pulsatil vascular pattern with a high average Ri (0,91) and Pi (3,46). The analysis of datas for form, margin, echotextur, vascularisation shows no significant accumulation of sonographic features. The results of Ri and Pi-surveying have significant differences between the three major diagnosis: Ri und Pi measured in tumors are significantly lower (p<0,001) than in both, pneumonias and atelectasis. Pi in pneumonias is significantly lower than in atelectasis (p<0,027). Thoraxsonography presents according to our datas the following sensitivities, specificities and validities in diagnosing pneumonia, tumor and atelectasis: pneumonia: 91,2%, 95,5%, 91%; tumor: 84,2%, 96,1%, 94%; atelectasis: 100%, 93,3%, 75%. Malignat pulmonary leasons in general are discovered with a sensitivity of 91,5%, a specificity of 84,3% and a validity of 84%. The following conculsions were drawn: the low-impedant arterial flow patterns in lung tumors are likely to correspond with those in the bronchial arteries and not neoangiogenetic tumor vessels. The blood flow in tumor vessels is much rarer to be visualized with today`s Color Doppler devices. In spite the statistically proved differences resistive index and pulsatility index are no reliable tools for the diagnosis of pulmonary leasons.